Posts for: October, 2016

If you or a family member wears braces, you're used to visiting your orthodontist for adjustments and progress monitoring. But it's just as important that you continue regular visits with your family dentist, especially if you begin noticing abnormalities with your teeth and gums.

We need to be on alert for dental health because risks for disease increase during orthodontic treatment. Most oral infections arise from plaque, a thin film of bacteria and food particles on tooth surfaces. You avoid plaque buildup by brushing and flossing at least once a day and undergoing semi-annual office cleanings for any remaining plaque and calculus (hardened plaque deposits).

Braces, however, can complicate hygiene. It's harder to get into areas blocked by the brackets and wires with your brush or floss. This can quickly give rise to gingivitis, a form of periodontal (gum) disease characterized by gum swelling. If not treated, gum disease could eventually cause the gums to detach from the teeth and lead to bone and tooth loss.

The brackets and wires can also irritate the gums and cause them to swell or overgrow, a condition called hyperplasia. This further complicates proper hygiene, which then increases the risk for infection even more.

It takes more time and effort to brush and floss effectively while wearing braces. But it's necessary to prevent these problems. Interproximal brushes (which fit in the spaces between teeth) can help, as well as special floss threaders. You might also consider a water flosser, which use a high-pressured water spray to remove plaque between teeth.

And, don't neglect seeing us on a regular basis. If you notice gum swelling, redness or bleeding, contact us as soon as possible.

If the swelling is due to hyperplasia, treatment could wait until after the braces come off, as long as there doesn't appear to be any gum detachment from the teeth. If there is, though, you may need to see a periodontist (a gum specialist) for further evaluation. It may be necessary in advanced cases to remove the braces to treat the underlying gum condition.

It pays to keep a close eye on your teeth and gums while wearing braces. Catching problems before they become too serious will help ensure your new smile is just as healthy as it is attractive.

When is the best time to floss your teeth: Morning? Bedtime? How about: whenever and wherever the moment feels right?

For Cam Newton, award-winning NFL quarterback for the Carolina Panthers, the answer is clearly the latter. During the third quarter of the 2016 season-opener between his team and the Denver Broncos, TV cameras focused on Newton as he sat on the bench. The 2015 MVP was clearly seen stretching a string of dental floss between his index fingers and taking care of some dental hygiene business… and thereby creating a minor storm on the internet.

Inappropriate? We don't think so. As dentists, we're always happy when someone comes along to remind people how important it is to floss. And when that person has a million-dollar smile like Cam Newton's — so much the better.

Of course, there has been a lot of discussion lately about flossing. News outlets have gleefully reported that there's a lack of hard evidence at present to show that flossing is effective. But we would like to point out that, as the saying goes, “Absence of evidence is not evidence of absence.” There are a number of reasons why health care organizations like the American Dental Association (ADA) still firmly recommend daily flossing. Here are a few:

It's well established that when plaque is allowed to build up on teeth, tooth decay and gum disease are bound to follow.

A tooth brush does a good job of cleaning most tooth surfaces, but it can't reach into spaces between teeth.

Cleaning between teeth (interdental cleaning) has been shown to remove plaque and food debris from these hard-to-reach spaces.

Dental floss isn't the only method for interdental cleaning… but it is recognized by dentists as the best way, and is an excellent method for doing this at home — or anywhere else!

Whether you use dental floss or another type of interdental cleaner is up to you. But the ADA stands by its recommendations for maintaining good oral health: Brush twice a day for two minutes with fluoride toothpaste; visit your dentist regularly for professional cleanings and checkups; and clean between teeth once a day with an interdental cleaner like floss. It doesn't matter if you do it in your own home, or on the sidelines of an NFL game… as long as you do it!

Braces can be a long, involved process, but gaining a more attractive smile and better oral health is worth it. Sometimes, though, braces can produce unintended short-term consequences.

Brace brackets and wires do the work of moving teeth to better positions. They can, however, hinder the wearer's hygiene efforts to remove plaque, a thin film of bacteria and food particles, from tooth surfaces. Plaque buildup increases the risk of dental disease and other ill effects.

One such effect while you're wearing braces is the formation of tiny spots that look pale and chalky on otherwise smooth and polished enamel. These are white spot lesions (WSLs), where acid has remained for too long on the tooth enamel. They occur because acid-producing bacteria escape removal during brushing and flossing due to the braces hardware.

We want to try to prevent WSLs while wearing braces, and not just because they're unattractive. You're actually looking at enamel erosion, which could lead to cavity development at those weakened spots.

Although difficult for you as a braces wearer, daily brushing and flossing is crucial to WSL prevention. You'll need to take more time to be sure you're reaching all around the wires and brackets. You can improve your effectiveness with special brushes for braces and floss threaders or water irrigators. You can also help keep acid levels low by cutting back on acidic foods and beverages, especially sodas, coffee or spicy foods.

Even if you develop WSLs we can treat them effectively, especially if caught early. One way is by aiding enamel re-mineralization through saliva stimulation (the mouth's acid neutralizer) or applying fluoride to the teeth to strengthen enamel. We can also use caries infiltration, a technique that injects tooth-colored resin below the surface of the lesion. This strengthens the weakened enamel and gives the area the appearance of translucence like normal enamel.

While you're wearing braces, focus diligently on keeping your teeth clean of plaque and keep up your regular cleaning visits with us. If you notice any unusual discolorations or abnormalities, see us as soon as possible. Stopping WSLs from developing will help ensure your teeth are healthy and attractive after the braces come off.

It's a common question we get from many concerned parents. Their exasperation involves more than having to wake every night to the annoying sounds coming from their child's bedroom: they're also worried about any potential damage occurring to their teeth.

Teeth grinding and similar habits fall under the umbrella term “bruxism.” In basic terms, bruxism is the involuntary movement of the teeth and jaws not engaged in regular functions like chewing, speaking or swallowing. Bruxism is actually common among pre-adolescent children, considered by many healthcare professionals as normal behavior like thumb sucking.

It's not fully known why children grind their teeth, especially during sleep. Stress can play a part, but many believe it could also be related to immaturity on the part of the neuromuscular system that controls chewing. In some cases it could be linked to sudden arousals from sleep, particularly if the child is prone to airway obstruction causing sleep apnea. And there may be a link with certain medications, especially for hyperactivity disorders like attention deficit hyperactivity disorder (ADHD).

Most children eventually outgrow the habit. If it persists, though, it can contribute to teeth problems. Teeth can withstand a lot of biting force, but when chronically exposed to the higher than normal forces produced during teeth grinding they can begin to wear. Sodas, fruit juices, sports drinks or similar acidic beverages complicate matters because they increase mouth acid that can soften enamel. And besides dental issues, teeth grinding can also cause jaw problems, ear pain and headaches.

If symptoms begin to appear, we can take steps to reduce the effect of teeth grinding, such as a mouth guard worn at night to reduce biting forces and protect against wear. We can also look at curbing consumption of acidic foods and beverages, addressing possible airway obstructions, changing medications or counseling for psychological stress.

As with thumb sucking, there's no cause for immediate alarm if your children grind their teeth. But if it continues on into their later childhood years or begins to affect their health and well-being, we'll need to intervene to prevent further harm.

We treat most malocclusions (bad bites) with braces or clear aligners. But not all malocclusions are alike — some can require extra procedures to achieve successful results.

One such example is when incoming teeth crowd other teeth and cause them to erupt abnormally. The crowding also reduces the space needed to move the misaligned teeth to better positions. To make more room we'll often remove some of the teeth before undertaking orthodontics.

The key is to extract the right teeth. The best candidates are those whose absence will have minimal effect on both appearance and dental function. That's commonly the bicuspids, located right on the edge of the “smile zone” (the teeth most visible when we smile) between the cuspid (eye) teeth and the back molars.

Once we choose and remove the teeth our next concern is to protect the bone at the extraction site.Â The bone in our jaws benefits from the pressure created when we bite or chew. This stimulates new bone cells to form and replace older cells. Without it, as when we have a missing tooth, the amount of bone can diminish over time and affect the success of any future orthodontics.

To prevent this, we take care not to damage the gums and bone removing the tooth. We may also install a graft under the empty socket to encourage bone growth.

If we've removed teeth outside the smile zone, the resulting orthodontics will move teeth into the opened space. In the end, you won't even notice they're gone. Teeth lost or congenitally missing in the smile zone, though, may eventually require a replacement tooth. A dental implant is the best choice, but it should be put on hold for a younger person until their jaw has fully developed.

In the meantime, we can install a spacer or a temporary restoration to hold the empty space and prevent other teeth from drifting into it. This can be incorporated into braces or aligners, or with a removable partial denture or a temporary modified bridge.

Extracting teeth to aid orthodontics first requires a well-laid plan that could encompass several years. The end result, though, can be well worth the time and effort — better function and a new, attractive smile.